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Safety Recommendation Details

Safety Recommendation A-14-100
Details
Synopsis: On March 30, 2013, at 2320 Alaska daylight time, a Eurocopter AS350 B3 helicopter, N911AA, impacted terrain while maneuvering during a search and rescue (SAR) flight near Talkeetna, Alaska. The airline transport pilot, an Alaska state trooper serving as a flight observer for the pilot, and a stranded snowmobiler who had requested rescue were killed, and the helicopter was destroyed by impact and postcrash fire. The helicopter was registered to and operated by the Alaska Department of Public Safety (DPS) as a public aircraft operations flight under 14 Code of Federal Regulations Part 91. Instrument meteorological conditions (IMC) prevailed in the area at the time of the accident. The flight originated at 2313 from a frozen pond near the snowmobiler’s rescue location and was destined for an off-airport location about 16 mi south.
Recommendation: TO FORTY FIVE STATES, THE COMMONWEALTH OF PUERTO RICO AND THE DISTRICT OF COLUMBIA: Develop and implement a flight risk evaluation program that includes training for all employees involved in the operation and procedures that support the systematic evaluation of flight risks and consultation with others trained in flight operations if the risks reach a predefined level.
Original recommendation transmittal letter: PDF
Overall Status: Open - Await Response
Mode: Aviation
Location: Talkeetna, AK, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: ANC13GA036
Accident Reports: ​Crash Following Encounter with Instrument Meteorological Conditions After Departure from Remote Landing Site Alaska Department of Public Safety Eurocopter AS350 B3, N911AA
Report #: AAR-14-03
Accident Date: 3/30/2013
Issue Date: 11/24/2014
Date Closed:
Addressee(s) and Addressee Status: Commonwealth of Kentucky (Open - Await Response)
Commonwealth of Massachusetts (Open - Await Response)
Commonwealth of Pennsylvania (Closed - Reconsidered)
Commonwealth of Puerto Rico (Open - Acceptable Response)
Commonwealth of Virginia (Open - Await Response)
District of Columbia (Open - Await Response)
State of Alabama (Open - Acceptable Response)
State of Alaska (Open - Acceptable Response)
State of Arizona (Closed - Reconsidered)
State of Arkansas (Closed - Reconsidered)
State of California (Open - Await Response)
State of Colorado (Closed - Reconsidered)
State of Connecticut (Open - Await Response)
State of Delaware (Closed - Reconsidered)
State of Florida (Open - Acceptable Response)
State of Georgia (Closed - Reconsidered)
State of Illinois (Closed - Acceptable Action)
State of Indiana (Open - Await Response)
State of Iowa (Closed - Reconsidered)
State of Kansas (Open - Acceptable Response)
State of Louisiana (Open - Await Response)
State of Maine (Open - Await Response)
State of Maryland (Closed - Reconsidered)
State of Michigan (Closed - Reconsidered)
State of Minnesota (Open - Acceptable Response)
State of Mississippi (Open - Await Response)
State of Missouri (Open - Await Response)
State of Montana (Closed - Reconsidered)
State of Nebraska (Open - Await Response)
State of Nevada (Open - Await Response)
State of New Hampshire (Open - Await Response)
State of New Jersey (Closed - Reconsidered)
State of New Mexico (Open - Await Response)
State of New York (Open - Await Response)
State of North Carolina (Closed - Acceptable Action)
State of North Dakota (Open - Await Response)
State of Ohio (Closed - Acceptable Action)
State of Oklahoma (Open - Acceptable Response)
State of Oregon (Open - Await Response)
State of South Carolina (Open - Await Response)
State of South Dakota (Closed - Reconsidered)
State of Tennessee (Open - Await Response)
State of Texas (Closed - Acceptable Action)
State of Utah (Closed - Reconsidered)
State of Washington (Closed - Reconsidered)
State of West Virginia (Open - Await Response)
State of Wisconsin (Open - Await Response)
Keyword(s):

Safety Recommendation History
From: NTSB
To: State of Alabama
Date: 5/4/2015
Response: We note that ALEA has a flight risk evaluation program in place; however, we would like to know whether all employees involved in operations receive the recommended training. Pending our receipt and review of this additional information, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Alabama
To: NTSB
Date: 2/9/2015
Response: -From J. Spencer Collier, Secretary, Alabama Law Enforcement Agency: Approximately four (4) years ago, ALEA Aviation initiated the Pre-flight/Self Analysis form. This form, attached in the appendix (ref. A-14-100}, was implemented to improve awareness of the hazardous areas of operations that our pilots find themselves in as it pertains to weather, fatigue, day vs. night vision goggle operations. Pilots are required to notify the Chief Pilot (or Assistant Chief Pilot when Chief Pilot is not available) any time they are preparing to launch on a mission and their PSA form indicates the cautionary (yellow) range. This gives the Chief Pilot the ability to plan for schedule changes that include sending a relief crew to the scene of a search or rescheduling a flight to allow for adequate crew rest.

From: NTSB
To: State of Alaska
Date: 3/30/2015
Response: We note that you have developed a flight risk assessment tool and that you plan to require its use by all Alaska Department of Public Safety pilots. We also note that all employees involved in the operation are trained and that all flights are approved by the check airman or aviation section supervisor. Pending confirmation from you that your program has been fully implemented statewide, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Alaska
To: NTSB
Date: 12/16/2014
Response: -From Gary Folger, Commissioner, Department of Public Safety: Beginning in the summer of 2014, a flight risk assessment tool was made mandatory for all A Star helicopter pilots based out of Anchorage and Fairbanks for every flight conducted. This tool includes both self-evaluation and peer review of flight conditions. Flights are not authorized or launched unless pilots have completed the flight risk assessment tool and it has been approved by a department check airman or the aircraft section supervisor. In rare circumstances, flight risk assessments may be elevated to the level of the Director of the organization. This assures that senior leaders within the department are fully aware of risks associated with certain missions. Further, in November 2014, the aircraft section held a three day safety stand-down where all DPS pilots were trained on the new flight risk assessment tool. DPS plans to have this fully implemented for all department pilots statewide by the summer of 2015.

From: NTSB
To: State of Arizona
Date: 1/18/2018
Response: We note that, in 2008, the AZDPS implemented a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment with predetermined levels of risk that require management approval if the risk reaches an established level, and that this program includes training. Because these measures were in place before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED--RECONSIDERED.

From: State of Arizona
To: NTSB
Date: 9/13/2017
Response: Terry S. Miyauchi, Aviation Administrator, Arizona Department of Public Safety: The purpose of this letter is to respond to your safety recommendations letter addressed to Governor Doug Ducey, dated August 3, 2017. In that letter, NTSB Safety Recommendations A-13-21 (meteorological evaluation towers) andA-14-100 through 106 (search-and-rescue flight) were provided to the State of Arizona. The Arizona Department of Public Safety (AZDPS) conducts flights across the entire state of Arizona, to include areas where meteorological towers have been erected. Approximately 25% percent of all flights for AZDPS and the State are in support of search and rescue operations. We value the goal of aviation safety as the number one priority for all of our aviation activity and your recommendations are well received. We offer the following specific responses to each of your NTSB recommendations: In October 2008, AZDPS implemented a flight risk evaluation program consistent with the Federal Aviation Administration's Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services. AZDPS additionally has an Aviation Safety Council that oversees the program and provides training. Because of this, AZDPS was provided with a "Closed-Reconsidered" by the NTSB on May 22, 2014 in regards to the prior NTSB recommendation A-09-131. The above mentioned flight risk evaluation program and aviation safety council are still in effect today. Additionally, in July of2016, AZDPS instituted a daily Flight Risk Assessment Tool (FRAT) for daily use on all helicopter activity as it pertains to not just search-and-rescue operations, but all flight mission profiles.

From: NTSB
To: State of Arizona
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Arizona on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Arizona on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Arkansas
Date: 12/15/2017
Response: We are now aware that, in 2013, the ASP implemented a flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined risk levels that require management approval if the risk reaches an established level. We are also aware that all individuals involved in SAR operations are trained on the program. Because this program was in place before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED--RECONSIDERED.

From: State of Arkansas
To: NTSB
Date: 8/29/2017
Response: -From Asa Hutchinson, Governor: Arkansas executive branch agencies involved in civilian aviation use a flight risk evaluation program which includes training for all crew members and implements a risk evaluation prior to each flight.

From: NTSB
To: State of Arkansas
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Arkansas on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Arkansas on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of California
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of California on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of California on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Colorado
Date: 1/3/2018
Response: We note that the Colorado Army National Guard operates helicopters to conduct SAR missions, and that the Colorado State Police does not operate helicopters. We believe that all air operations could benefit from the safety improvements specified in these recommendations, and we urge the state of Colorado to make the recommended safety improvements to all its air operations. However, because these recommendations were specifically aimed at public operators who conduct helicopter SAR operations, Safety Recommendations A-14-100 through -106 are classified CLOSED--RECONSIDERED.

From: State of Colorado
To: NTSB
Date: 9/13/2017
Response: -From John W. Hickenlooper, Governor: We have enacted recommendation A-13- 21 through legislation, when we signed House Bill 14-1216 into law in 2014. This bill requires safety markings for certain towers over 50 feet in height that are located in unincorporated areas of the state, and has been incorporated into Colorado Revised Statutes (CRS) section 43-10-117. Specifically, CRS 43-10- 117 requires: (2) Where the appearance of a tower is not otherwise governed by state or federal law, rule, or regulation, any tower over fifty feet in height that is located outside the boundaries of an incorporated city or town on land that is primarily rural or undeveloped or used for agricultural purposes must be marked and painted or otherwise constructed to be visible in clear air during daylight hours from a distance of not less than two thousand feet. Towers must also comply with the following additional requirements: (a) A tower must be painted in equal alternating bands of aviation orange and white, beginning with orange at the top of the tower; (b) One marker ball must be attached to the top third of each outside guy wire; and (c) Guy wires must have a seven-foot- long safety sleeve at each anchor point that extends from the anchor point along each guy wire attached to the anchor point. (3) Any tower that was erected prior to August 6, 2014, must be marked as required by the provisions of this section within one year of August 6, 2014. Any tower that is erected on or after August 6, 2014, must be marked as required by this section at the time it is erected. The Colorado Army National Guard operates helicopters that are used in search and rescue missions, and they report that compliance with all recommendations as outlined in your document of August 3, 2017, as it pertains to the operation of helicopters. Finally, the Colorado State Patrol currently implements recommendation A-14-101, using procedures and avionics that allow for up-to-date weather information and assistance with flight risk assessment decisions. While they do not operate helicopters in search and rescue missions, they are considering implementing recommendations A-14-100, A-14-105, and A-14-106 following an independent and unrelated safety audit they are conducting. Once completed, we will incorporate regulations that are in compliance with the NTSB recommendation, at a minimum. Again, thank you for your correspondence regarding this issue. Please don’t hesitate to reach out to my Office should you have any further questions.

From: NTSB
To: State of Colorado
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Colorado on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Colorado on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Connecticut
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Connecticut on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Connecticut on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Delaware
Date: 5/15/2015
Response: We note that you have a flight risk evaluation program in place and that all employees involved in operations receive the recommended training. These actions satisfy the intent of this recommendation; however, because they were implemented before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED-RECONSIDERED.

From: State of Delaware
To: NTSB
Date: 12/8/2014
Response: -From Colonel Nathaniel McQueen, Jr., Superintendent, Delaware Department of Safety and Homeland Security, Division of State Police: Delaware State Police dispatch aircraft from 2 locations covering 3 counties. DSP aircraft can be dispatched by police or fire public safety answering point personnel, based on a request from the field or through automatic dispatch protocols. After dispatch, flight crews conduct flight following by radio with our aviation communications center (AVCOM), which is located in the central county dispatch center. Crews provide departure, arrival, estimated times of arrival and numbers of passengers onboard the aircraft to the dispatch center. With the addition of Sky Node equipment to the aircraft in 2014, real time flight tracking will be accomplished in our dispatch centers. Currently staff members who dispatch aircraft have not received formal training as weather observers, HEMS operations, and have limited operational control during responses. Future plans include, working towards a more formal dispatch program implementing the recommendations of FAA AC 120-96.

From: NTSB
To: District of Columbia
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the District of Columbia on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the District of Columbia on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Florida
Date: 5/4/2015
Response: We note that the FWC has developed a flight risk assessment program, which includes the use of a flight risk assessment tool, and is in the process of updating its flight manual to include the recommended assessment program. Please also inform us about whether training on the flight risk assessment program is provided to all employees involved in the operation. Pending our receipt of this additional information, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Florida
To: NTSB
Date: 1/30/2015
Response: -From Colonel Curtis Brown, Florida Fish and Wildlife Conservation Commission Director, Division of Law Enforcement: FWC Aviation has an internal flight risk assessment program that identifies the potential hazards and risks associated with our flight operations. It implements controls and countermeasures, effectively reducing overall risk levels. The risk assessment is designed to foster a safety climate in which a crewmember freely identifies risks associated with his or her flight operations. Controls are initially implemented at the operator level, but then rise to an aviation supervisor if risk exceeds the pre-established level. Our flight manual currently establishes weather minimums for both fixed wing and rotor aircraft for inland and offshore areas. The manual is being updated to reflect the inclusion of a safety management system program, which will explain the implementation and use of flight risk assessment. The risk assessment was developed by the FWC aviation staff members, including those with flight operations experience, and in conjunction with the Airborne Law Enforcement Association (ALEA).

From: NTSB
To: State of Georgia
Date: 3/6/2015
Response: We are aware that, in 2012, you implemented a flight risk evaluation program and that you provide training for all employees involved in operations. Because these actions were completed before Safety Recommendation A-14-100 was issued, the recommendation is classified CLOSED—RECONSIDERED.

From: State of Georgia
To: NTSB
Date: 12/8/2014
Response: -From Colonel Mark McDonough, Commissioner, Department of Public Safety: Georgia State Patrol Aviation Division (Division) is currently using a commercial online Aviation Safety Management System (SMS) for flight organizational compliance, standards, manuals, tracking and reporting. The SMS, designed by Baldwin Aviation Inc., enables the organization to monitor and enhance the safety culture while simplifying compliance with industry standards, regulations and practices. The SMS has a detailed risk assessment, which allows the Division members to see risk associated with a mission. The risk assessment provides a score. If the risk assessment score reaches a certain number, the pilot must receive approval from the Aviation Director before the flight. The Division began using the SMS in January of 2011. Pilots, mechanics and tactical flight officers completed training from the vendor at the time of purchase. New employees to the Aviation Division are trained by the Safety Risk Manager.

From: NTSB
To: State of Illinois
Date: 11/20/2015
Response: We note that the ISP has a flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require management approval if the risk reaches an established level. We further note that all employees involved in ISP operations receive the recommended training. These actions satisfy Safety Recommendation A-14-100, which is classified CLOSED—ACCEPTABLE ACTION.

From: State of Illinois
To: NTSB
Date: 8/27/2015
Response: -From Leo P. Schmitz, Director, Illinois State Police: The Illinois State Police (ISP) Air Operations Bureau (AOB) trains pilots on the hazards associated with the airspace in which they operate. This training includes operational considerations when flying in Air Traffic Control (ATC) airspace, near sensitive infrastructure, and in special use airspace (i.e., Military Operating Areas) as well as any known ground-based hazards or obstructions. Each pilot is trained how to identify any hazards in the area and to assess the weather conditions throughout their flight. A formal checklist is somewhat cumbersome and not practical as our pilots may be conducting one type of law enforcement operation only to be dispatched to a different location with a different type of mission. The pilot continually must assess the location of these hazards and risks. The ISP will develop and implement a Safety Risk Analysis Checklist (SRAC) for flights conducted in Illinois. Once complete, the SRAC will be issued to each pilot. The SRAC will: • Identify sensitive infrastructure and other areas within the jurisdiction where the risks of f1ight may impact persons and property on the ground. The SRAC will identify any additional safety risks specific or unique to their jurisdiction. • Indicate appropriate risk mitigations or controls for each safety risk identified. The SRAC should be reviewed and updated by the Agency at least annually and more often if additional safety risks are identified. UPDATE: The ISP AOB now utilizes a formalized Flight Risk Assessment Tool (FRAT) in accordance with Airborne Law Enforcement Association (ALEA) guidelines, which is tailored specifically to ISP flight operations. The FRAT categorizes the risk of each mission as low risk or "Acceptable," medium risk or "Caution," or "High Risk." Pilots may approve flights/missions falling in the low risk category; however, the AOB Operations Officer must approve missions deemed medium risk. The AOB Chief Pilot and/or Bureau Chief must approve missions in the high risk category. The FRAT was developed and each pilot was trained on its use at the second quarter flight review check. See sample FRAT attached.

From: NTSB
To: State of Illinois
Date: 6/10/2015
Response: We note that, although the ISP’s pilots are trained on the hazards associated with the airspace in which they operate, the ISP does not have a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with search and rescue (SAR) operations if the risk reaches an established level. We are encouraged to learn, however, that the ISP is in the process of developing a checklist to help its pilots identify other potential safety risks and the appropriate action(s) to mitigate those risks. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low, medium, or high, the tool calculates a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the medium range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage the ISP to review Federal Aviation Administration (FAA) Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS). Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on your progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Illinois
To: NTSB
Date: 2/26/2015
Response: -From Leo P. Schmitz, Director, Illinois State Police: The Illinois State Police (ISP) Air Operations Bureau (AOB) trains pilots on the hazards associated with the airspace in which they operate. This training includes operational considerations when flying in Air Traffic Control (ATC) airspace, near sensitive infrastructure and in special use airspace (i.e. Military Operating Areas) as well as any known ground-based hazards or obstructions. Each pilot is trained in how to identity any hazards in the area and to assess the weather conditions throughout their flight. A formal checklist is somewhat cumbersome and not practical as our pilots may be conducting one type of law enforcement operation only to be dispatched to a different location with a different type of mission. The pilot continually must assess the location of these hazards and risks. The ISP will develop and implement a Safety Risk Analysis Checklist (SRAC) for flights conducted in Illinois. Once complete, the SRAC will be issued to each pilot. The SRAC will: • Identify sensitive infrastructure and other areas within the jurisdiction where the risks of flight may impact persons and property on the ground. The SRAC will identify any additional safety risks specific or unique to their jurisdiction. • Indicate appropriate risk mitigations or controls for each safety risk identified. The SRAC should be reviewed and updated by the Agency at least annually and more often if additional safety risks arc identified.

From: NTSB
To: State of Indiana
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Indiana on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Indiana on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Iowa
Date: 10/26/2017
Response: We note that the state of Iowa does not conduct helicopter SAR operations; however, we believe that all air operations could benefit from the safety improvements specified in these recommendations. Accordingly, we urge the state of Iowa to make the safety improvements discussed in these recommendations to all its air operations. Because these recommendations were specifically aimed at public operators who conduct helicopter SAR operations, though, Safety Recommendations A 14-100 through -106 are classified CLOSED--RECONSIDERED.

From: State of Iowa
To: NTSB
Date: 8/10/2017
Response: -From Tim McClung, Iowa DOT, Office of Aviation: Thank you for the NTSB’s August 3, 2017 letter to Iowa Governor Kim Reynolds regarding NTSB safety recommendations A-14-100 through -106. The letter indicates the recommendations were issued as a result of the investigation into an accident involving a Eurocopter AS350 B3 owned and operated by the Alaska Department of Public Safety. Iowa does not own or operate helicopters for use in public safety efforts and therefore does not engage in Night Vision Goggle operations, off airport landings, or operations in mountainous areas. Accordingly, the recommendations would not apply. This communication is intended to provide information needed to close the response status for Iowa on these recommendations. Please let me know if you need additional information.

From: NTSB
To: State of Iowa
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-14-100 through -106. We issued these recommendations to the state of Iowa on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search and rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Kansas
Date: 5/4/2015
Response: We note that, although you provide guidance to your pilots for evaluating flight conditions before taking off, you do not have a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with SAR operations if the risk reaches an established level. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low, medium, or high, the tool calculates a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage you to review Federal Aviation Administration (FAA) Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS). Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on your progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Kansas
To: NTSB
Date: 1/30/2015
Response: -From Mark A. Bruce, Colonel, Superintendent, Kansas Highway Patrol: Recently we received a copy of the NTSB's proposed safety recommendations (attached) from your office. We have reviewed them and assessed the impact to KHP aircraft operations. We anticipate the impact to be similar in nature to other law enforcement aircraft operations within the state of Kansas. Below is our assessment and response to those specific NTSB safety recommendations. We appreciate the spirit and nature of the recent recommendations (A-14-100 through -106) provided by the NTSB in their letter dated November 24, 2014. We have not taken the recommendations lightly and have reviewed them for their well-intentioned benefits. Part of our review has included the referenced accident involving the Alaska Department of Public Safety Eurocopter AS350 B3 helicopter in March of 2013. Keeping the purpose of the recommendations in mind, as well as our already high commitment to safety, we must mention that a considerable obstacle to implementation of several of the proposed measures is cost. Many states and their government agencies have fiscal challenges, and the Kansas Highway Patrol is no exception. While a price cannot be put on a life, we have a responsibility to the public we serve with the very nature of the services we provide, as well as to the employees we request to carry out those services. In return for our responses, we would very much appreciate reciprocation by being provided the responses of other agencies from other states as well. Their opinions and recommendations could be quite valuable. This would also encourage an open dialogue without unintentionally suppressing potentially innovative methods to pursue best practices in a more cost effective manner. Kansas Highway Patrol (KHP) policy provides guidance to pilots for evaluating flight conditions before taking flight missions. While no formal risk assessment form is currently used to document the conditions prior to departure, a form could be easily drafted that would allow pilots to self-assess the risk for each mission prior to takeoff. Such a form should be simple, quick and easy to use. In order to reduce confusion, duplicity, and extraneous information, agencies should design their own form in order to address specific areas of concern for their unit such as geography, weather patterns, etc.

From: NTSB
To: Commonwealth of Kentucky
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-14-100 through -106. We issued these recommendations to the commonwealth of Kentucky on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Louisiana
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Louisiana on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Louisiana on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Maine
Date: 7/6/2018
Response: On March 26, 2018, Major Christopher Grotton, MSP, informed our staff that the MSP operates two fixed wing aircraft, mostly for law enforcement missions. Major Grotton reported that the MSP does not operate any helicopters, but that the Maine Forest Service operates helicopters. On April 5, 2018, Mr. John Crowley, Maine Forest Service, informed our staff that the Maine Department of Inland Fisheries and Wildlife is the state organization responsible for conducting SAR missions; however, because the Maine Department of Inland Fisheries and Wildlife does not operate any helicopters, the Maine Forest Service assists with SAR missions that require the use of helicopters. Because these recommendations were specifically aimed at public operators who conduct helicopter SAR operations, we believe that the Maine Forest Service is the appropriate state organization to respond to Safety Recommendations A-14-100 through -106, and Mr. Crowley informed us that he is in the process of developing a response. Pending our receipt of this information, Safety Recommendations A-14-100 through -106 remain classified OPEN--AWAIT RESPONSE.

From: State of Maine
To: NTSB
Date: 2/12/2018
Response: -From Major Christopher Grotton, Maine State Police, Support Services Division: This letter is in response to the NTSB Safety Recommendations A-13-21 and A-14-100 through -106 issued to the State of Maine in an August 2017 letter to Governor LePage. The Maine State Police Air Wing has a small profile within the overall scope of aviation operations conducted within the State of Maine. We have two fixed wing aircraft in our inventory with no rotary wing asset. Our core mission is primarily traffic related flights which are conducted during the daylight and in VFR conditions only. Any night VFR or day/night IFR flights that are requested would typically be administrative in nature and would be conducted operating under part 91 regulations. When requested, we assist other aviation assets and agencies within the state under the conditions that the flight can be done within the confines of our Standard Operating Procedures Manual and our General Orders that pertains to the Air Wing. Any search and rescue mission that we would be involved in would be conducted during daylight VFR only conditions. Our aircraft are equipped with wheels only and are not allowed to perform "off-site" landings. We are restricted to published airports only. Those flights would also be conducted utilizing part 91 regulations. I am in hopes that this information provides some context for our air operations and the applicability of the recommendations in your August 2017 letter. Our responses (below) to each of your recommendations are crafted within the context of our mission. Although our air wing operates under part 91, we realize that utilizing a tool such as a Risk assessment form would be beneficial. It is our plan to develop a risk assessment form within the next year to utilize the industry's best practices and methods. We will also tailor it to our mission profile.

From: NTSB
To: State of Maine
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Maine on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Maine on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Maryland
Date: 7/15/2015
Response: We understand that the MSP developed and implemented the recommended mission specific flight risk assessment program before we issued this recommendation. Accordingly, Safety Recommendation A-14-100 is classified CLOSED—RECONSIDERED.

From: State of Maryland
To: NTSB
Date: 3/25/2015
Response: From Michael W. DeRuggiero, Safety Management Officer, Aviation Command, Maryland State Police: In an effort to address NTSB recommendation A-09-131, the MSPAC began development of an "excel" based "Risk Assessment" (RA) Tool in November 2008 (Attachment 1 ). The RA Tool was designed to help flight crews identify and mitigate flight risk that could have a negative impact on flight safety, as well as require operational oversight from MSPAC's Director of Flight Operations when assessed risk reached a predetermined threshold prior to a flight crew accepting a flight request. In January 2009, a "beta" version of the RA Tool was completed and all MSPAC flight personnel were trained on its use. The use WB/RA Tool was then implemented within the MSPAC and "beta tested" by all MSPAC flight personnel until October 2009. During this period, the RA Tool was combined with MSPAC's "Weight and Balance'' excel based program. Input from flight crew members was solicited during this period with regard to the WB/RA Tool's ease of use, threshold crews was officially codified when the Commander of the MSPAC signed Active Flight Policy #88 on November 13, 2009 (Attachment 2).

From: NTSB
To: Commonwealth of Massachusetts
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the commonwealth of Massachusetts on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the commonwealth of Massachusetts on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Michigan
Date: 9/16/2015
Response: We are pleased to learn that, in August 2014, the MSP Aviation Unit implemented a flight risk evaluation program that includes training for all employees. Because these actions were completed before Safety Recommendation A-14-100 was issued, the recommendation is classified CLOSED—RECONSIDERED.

From: State of Michigan
To: NTSB
Date: 6/29/2015
Response: -From Colonel Kriste Kibbey Etue, Director, Michigan State Police: The Aviation Unit Operations Manual follows the guideline established by the Airborne Law Enforcement Association (ALEA) accreditation standards. All employees of the Aviation Unit have a copy of the Operations Manual and receive training on the procedures included in that manual. Further training is conducted specifically on the flight risk assessment forms and how they are completed. The mission is evaluated based on complexity, crew, and includes environmental factors. Once the mission is evaluated on the different factors a total risk value is generated for the mission. That value is compared against established thresholds for low, medium, and high risk missions. Low risk missions require a district commander's approval, medium risk requires a bureau commander's approval, and a high risk mission can only be approved by the Director. Training has been conducted with all employees to ensure they understand the processes.

From: NTSB
To: State of Michigan
Date: 6/10/2015
Response: We note that current MSP procedures include a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from a designee one step removed from the launch decision if the risk reaches an established level. However, we would like to know whether all employees involved in operations receive the recommended training. Pending our receipt and review of this additional information, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Michigan
To: NTSB
Date: 1/23/2015
Response: -From Col. Kriste Kibbey Etue, Director, Michigan State Police and Kirk T. Steudle, Director, Michigan Department of Transportation: • The MSP Aviation Unit has adopted a flight risk assessment tool that consists of five critical safety areas to be assessed prior to every aviation mission. The five safety areas assessed are: flight planning, mission type and complexity, weather, crew rest, and crew experience. Each mission is scored according to the associated risk involved. There are three predefined levels of risk identified in the-scoring process. Each predefined level requires a higher level of approval within the chain of command, commensurate with the level of risk involved. • The MDOT Office of Aeronautics (Aero) has been in the process of updating and enhancing its flight operations manual and standard operating procedures to develop a safety management system (SMS), which includes a flight risk evaluation program.

From: NTSB
To: State of Minnesota
Date: 5/4/2015
Response: We note that current MSP procedures and training include risk evaluation; however, we would like to know whether the MSP has a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with SAR operations if the risk reaches an established level. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low, medium, or high, the tool calculates a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage the MSP to review Federal Aviation Administration (FAA) Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS). Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on MSP progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Minnesota
To: NTSB
Date: 1/30/2015
Response: -From Colonel Matthew C. Langer, Chief, Minnesota State Patrol: Current procedures include training in operations and procedures, and include procedures for careful risk evaluation.

From: NTSB
To: State of Mississippi
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Mississippi on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Mississippi on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Missouri
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Missouri on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Missouri on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Montana
Date: 10/26/2017
Response: We note that the Montana Highway Patrol (MHP) operates two aircraft for law enforcement missions; however, as Mr. John Spencer, MHP, informed our staff on October 4, 2017, SAR operations are not the MHP’s primary mission, but fall under the purview of the county sheriff’s offices. We believe that all air operations could benefit from the safety improvements specified in these recommendations, and we urge the state of Montana to make the recommended safety improvements to all its air operations. However, because these recommendations were specifically aimed at public operators who conduct helicopter SAR operations, Safety Recommendations A 14-100 through -106 are classified CLOSED--RECONSIDERED.

From: State of Montana
To: NTSB
Date: 8/18/2017
Response: -From Mike Tooley, Director, Montana Department of Transportation: The State of Montana appreciates the leadership your agency has provided to enhance and promote the safety of law enforcement public aircraft operations across the nation. The Montana Highway Patrol (MHP) operates a 1971 Bell OH-58A helicopter and a 1978 Cessna 182-RG airplane in its law enforcement mission, with a single officer responsible for all flying duties. Total flight hours are less than 100 hours per year. The MHP flight department has considered the NTSB Safety Recommendations and has implemented them in the following manner: The pilot routinely evaluates the risk level of the mission, as outlined in the flight operations manual. Missions that score high in risk are approved by the MHP Colonel.

From: NTSB
To: State of Montana
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-14-100 through -106. We issued these recommendations to the state of Montana on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue (SAR) flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Nebraska
Date: 8/3/2017
Response: We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE.

From: NTSB
To: State of Nevada
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Nevada on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Nevada on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of New Hampshire
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of New Hampshire on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of New Hampshire on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of New Jersey
Date: 6/24/2015
Response: We understand that the NJSP has a flight risk evaluation program in place and that all employees involved in operations receive the recommended training. These actions satisfy the intent of this recommendation; however, because they were implemented before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED—RECONSIDERED.

From: State of New Jersey
To: NTSB
Date: 2/26/2015
Response: -From Joseph R. Fuentes, Colonel, Superintendent: The New Jersey State Police Aviation Bureau incorporates this as part of our Safety Management System (SMS). We have developed mission specific flight risk assessments that are completed via web browser and are recorded for further review. This training has been provided to all employees and is shared via web site with all three aviation bases. The flight risk analysis tool quantifies risk for each individual flight. Flights whose risk is evaluated to be outside acceptable limits are reviewed by higher authority and mitigated or declined. Search and rescue operations require an additional briefing/checklist which is conducted by a supervisor not directly involved with the mission.

From: NTSB
To: State of New Mexico
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of New Mexico on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of New Mexico on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of New York
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of New York on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of New York on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of “Open—Await Response.” For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of North Carolina
Date: 6/10/2015
Response: We note that SHP has a flight risk evaluation program in place that requires the use of a risk assessment matrix and approval from an individual who is not part of the flight crew. We also note that all employees involved in operations receive the recommended training. These actions satisfy Safety Recommendation A-14-100, which is classified CLOSED—ACCEPTABLE ACTION.

From: State of North Carolina
To: NTSB
Date: 2/5/2015
Response: -From William Grey, Colonel, Commanding, North Carolina Department of Public Safety, State Highway Patrol: 1. We are working on implementing an improved risk evaluation matrix. The current “alpha” version of the risk evaluation matrix that the Patrol is using is a Microsoft Excel spreadsheet that produces a “Risk Score”. In its current format, the risk evaluation matrix is inaccessible during a mission and may not be accessible from the Pilot’s residence (after hours, early call-out requests). We are moving towards a web-based solution that allows aircrews to continually assess risks through the entirety of the flight. 2. Flight risks due to weather are mitigated by having published weather minimums that apply to the base of operation, the destination of flight and the path between the two. Observed and forecasted weather are used to make the “go, no-go” decision. Missions are strictly forbidden when observed and forecasted weather conditions are below minimums. 3. Flight risks due to flying into inadvertent instrument meteorological conditions are mitigated by requiring all Pilots-in-Command to have an instrument rating. All Pilots-in-Command are required to conduct a simulated IMC currency flight every 45 days. 4. Flight risks due to operating with Night Vision Goggles (NVG) are mitigated by requiring all pilots who have completed an NVG school to complete a 45-day NVG currency. NVG Currency is comprised of no less than one hour of flight in an aircrew and individually completing six NVG Operations as described in FAR 61.57(f). 5. Pilots-in-Command who exceed currency are required to complete one hour of refresher training with a Unit flight instructor. Unit NVG instructors conduct the NVG currency renewal flights. Unit Instrument rated instructors conduct the simulated IMC currency renewal flights. 6. All pilots receive no less than one hour of flight instruction every quarter from a Unit flight instructor. 7. All pilots receive an emergency procedure training refresher course conducted by our aircraft manufacturer’s training academy. 8. We have a “Do Not Disturb” policy (by SOP) for aircrew members when they are not on duty and in their rest period. 9. Final authority to accept or decline a mission (by SOP) belongs to the Pilot-in-Command. 10. We have instituted (by SOP) an “All aircrew to go, one to say no” philosophy where a flight cannot be conducted without full agreement of the aircrew. 11. We have a Mission Request Procedure flowchart. Individuals within Aircraft Operations and Troop I (organizational unit) have been provided a copy of the flow chart and have been trained in how to exercise the procedure.

From: NTSB
To: State of North Dakota
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-14-100 through -106. We issued these recommendations to the state of North Dakota on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Ohio
Date: 3/17/2015
Response: We note that you have a flight risk evaluation program in place and that training for all employees involved in operations is provided. Because these actions satisfy the intent of this recommendation, Safety Recommendation A-14-100 is classified CLOSED—ACCEPTABLE ACTION.

From: State of Ohio
To: NTSB
Date: 12/18/2014
Response: -From Cari R. Maines, Ohio State Highway Patrol, Office of the Superintendent: The Ohio State Highway Patrol’s Aviation Section was started in 1947 with the approval of Senate Bill 221. The following year we made the purchase of one fixed wing bonanza. The original mission intent was for disaster relief, air searches, transportation, aerial photography, and errands of mercy. We had one aircraft and one pilot. Today, 67 years later, we have 16 pilots, 1 office assistant, and 16 aircraft. Annually, we log around 7,000 flight hours. Our fleet includes: • 2 Cessna 172R Skyhawk fixed wing airplanes • 2 Cessna 182S Skylane fixed wing airplanes • 9 Cessna 182T Skylane fixed wing airplanes • 1 Cessna 208B Caravan fixed wing airplane • 2 American Eurocopter AS350B2 helicopters Our primary mission is aerial traffic enforcement, and it comprises approximately 85% of our flight time. The remaining flight time is spent conducting other missions, including: • Searches (stranded motorists, downed aircraft, lost children, elderly walkaways, drowning victims, manhunts, etc.) • Surveillance (criminal interdiction, reconnaissance) • Photo flights (crashes, evidentiary, reconnaissance) • Drug interdiction flights including marijuana eradication • Emergency transportation (personnel, blood relays) • Special response team operations • Training Since our inception, we have suffered three crashes. Two of those were fatal fixed wing crashes (1970 & 1976) and the other was a minor injury helicopter crash in 1993. Since 1976, we have accumulated over 250,000 hours of accident free fixed wing flight. Our operations are a bit unique compared to most state agencies. We only use personnel assigned to the Aviation Section as part of our flight crew. Every Trooper / Pilot has spent time in the field as a State Trooper. State Troopers applying for a Trooper/Pilot position must possess a Private Pilot’s License (Airplane – Single Engine Land) with an Instrument Rating prior to appointment. After spending some time in the Section, some of our pilots are then trained as Tactical Flight Officers. Our helicopter pilots are also chosen from among the Section’s fixed wing pilots. We make a concerted effort to make safety our highest priority. We believe that “If it’s predictable, it’s preventable.” We are proud to say that every recommendation issued was either current practice or being developed. The following paragraphs summarize the actions we have planned and/or taken during implementation of the NTSB recommendations. We began developing a flight risk evaluation program in July 2014. The initial phase of the program is scheduled to begin January 1, 2015. All units assigned to the Aviation Section have received baseline flight risk evaluation training and have been training on how to use the program. The system we have chosen was developed in-house based upon the template supplied by the Airborne Law Enforcement Association (ALEA). The system is quantitative in design and takes into account static and dynamic variables such as: • Pilot – Physical condition, medication, fatigue, and experience • TFO – Physical condition, medication, fatigue, and experience • Aircraft - Maintenance and performance • Weather – Ceiling, visibility, winds, convective activity, and forecast conditions • Mission – Type of mission, day, night, etc. Based upon the score received, the crew will be given one of the following responses: • “Green - Go” Cleared for the flight • “Yellow – Go” Proceed with increased caution • “Orange – Seek approval” Obtain approval for the flight before proceeding • “Red – No Go” Not cleared for the flight The Aviation Section Commander or the Flight Safety Officer must be notified and approve any flight that operates in the “Orange”.

From: NTSB
To: State of Oklahoma
Date: 12/15/2017
Response: We note that, although the Oklahoma Highway Patrol’s (OHP’s) flight operations manual includes procedures that relate to risk assessment, it does not have a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with SAR operations. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low (green), medium (yellow), or high (red), these tools calculate a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the yellow range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage the OHP to review Federal Aviation Administration (FAA) Notice N8000.301, “Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS).” Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on the OHP’s progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN--ACCEPTABLE RESPONSE.

From: State of Oklahoma
To: NTSB
Date: 8/16/2017
Response: -From Michael C. Thompson, Commissioner, Oklahoma Department of Public Safety: The Oklahoma Depa1iment of Public Safety et. al. the Oklahoma Highway Patrol Air Support Division's Standard Operating Procedures (SOP) as implemented in 2013 and revised in 2016 contain informal flight risk evaluation steps that apply to each mission based on weather, equipment checklist and individual pilot limitations. These steps do not currently include a risk assessment matrix or flight risk assessment tool. All pilots receive documented flight risk training as a part of both their initial training and recurrent training. Such training must be completed prior to operating as a pilot in command of any aircraft. All training is documented in their training file and monitored by the Air Support Commander.

From: NTSB
To: State of Oklahoma
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-14-100 through -106. We issued these recommendations to the state of Oklahoma on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of “Open—Await Response.” For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Oregon
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Oregon on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Oregon on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of “Open—Await Response.” For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: Commonwealth of Pennsylvania
Date: 1/19/2018
Response: We are pleased to learn that, prior to 2013, the PSP implemented a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment with predetermined levels of risk that require management approval if the risk reaches an established level, and we note that this program also includes training. Because this program was in place before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED--RECONSIDERED.

From: Commonwealth of Pennsylvania
To: NTSB
Date: 11/2/2017
Response: -Leslie S. Richards, Secretary Department of Transportation, Commonwealth of Pennsylvania: Recommendations A-14-100 through-106 were issued as a result of the NTSB investigation of the March 30, 2013 accident in which a Eurocopter AS350 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. The NTSB correspondence is primarily directed towards search and rescue operations by State agency aircraft helicopters. While PennDOT does not own helicopters, nor participate on air search and rescue operations, NTSB recommendations A-14-100 and 101 are also applicable to the Bureau's Flight Services section. PennDOT flight services employs a risk evaluation procedure for all missions, and aircraft pilots receive annual safety training that covers the operation, procedures, and risk management oversight for air mission support.

From: NTSB
To: Commonwealth of Pennsylvania
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the commonwealth of Pennsylvania on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the commonwealth of Pennsylvania on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: Commonwealth of Puerto Rico
Date: 6/10/2015
Response: We note that, although the PRPD has procedures in place related to risk assessment, it does not have a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with search and rescue (SAR) operations if the risk reaches an established level. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low, medium, or high, the tool calculates a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the medium range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage the PRPD to review Federal Aviation Administration (FAA) Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS). Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on your progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: Commonwealth of Puerto Rico
To: NTSB
Date: 2/23/2015
Response: -From Jose L. Caldero Lopez, P.R.P.D. Superintendent, Commonwealth of Puerto Rico: Our training plan has been restructures for ours pilots, crew chiefs and all aviation personnel in everything related to search and rescue missions, police interventions and interdiction missions under all scenarios faced by our personnel on a daily basis. Before every mission, the following is established: a- Specific plan of action b- Security guidelines c- Possible flight plan d- Weathers conditions e- Equipment utilized f- Potential scenarios Emphasis is made on what possible chain of events can eventually lead to an accident keeping in mind security so as to minimized risk involved within a well-established work plan.

From: NTSB
To: State of South Carolina
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of South Carolina on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of South Carolina on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of South Dakota
Date: 2/22/2018
Response: On January 16, 2018, Mr. Ron Hauck, Aviation Service, South Dakota Department of Transportation, infomed our staff that the South Dakota Highway Patrol operates fixed wing aircraft for law enforcement missions; however, the state does not operate any helicopters. We believe that all air operations could benefit from the safety improvements specified in these recommendations, and we urge the state of South Dakota to make the recommended safety improvements to its air operations. However, because these recommendations were specifically aimed at public operators who conduct helicopter SAR operations, Safety Recommendations A 14-100 through -106 are classified CLOSED--RECONSIDERED.

From: State of South Dakota
To: NTSB
Date: 11/21/2017
Response: -From Dennis Daugaard, Governor of South Dakota: As to recommendations A-13-21 and A-14-100 through -106, the South Dakota Highway Patrol has reviewed the recommendations, as well as the NTSB accident report, NTSB/AAR-14/03 PB2014-108877, including the findings, probable cause, and recommendations contained in that report. All flight operations conducted by the state of South Dakota are conducted under FAR Part 91 Rules and all FAR 91 Rules are currently being complied with. South Dakota will continue to conduct all flight operations in accordance with all federal aviation regulations.

From: NTSB
To: State of South Dakota
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of South Dakota on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of South Dakota on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of “Open—Await Response.” For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Tennessee
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Tennessee on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Tennessee on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: State of Texas
To: NTSB
Date: 9/4/2015
Response: -From Greg Abbott, Governor: Thank you for your letter addressed to former Governor Rick Perry regarding NTSB Safety Recommendations A-14-100 through 106. I am sharing your letter with the Texas Department of Transportation's Aviation Division, which will coordinate with my office in discussing the flight safety issues you addressed. Please let me know if I can assist you in the future.

From: NTSB
To: State of Texas
Date: 9/3/2015
Response: We note that, in June 2015, the DPS implemented a risk assessment program that incorporates (1) an effect/probability?type risk assessment and (2) predetermined levels of risk that require management approval if the risk reaches an established level. We also note that all employees involved in the operation receive training in the new program. These actions satisfy Safety Recommendation A-14-100, which is classified CLOSED—ACCEPTABLE ACTION.

From: State of Texas
To: NTSB
Date: 6/19/2015
Response: -From Steven C. McCraw, Director: The DPS Aviation safety/training team has been using the risk assessment program in accordance with N8000.301 helicopter emergency medical services recommendations. The assessment is filled out by the PIC and has graduated rankings that require supervisor or Chief Pilot input if the risk is elevated past predetermined thresholds. The risk analysis is performed using the online data monitoring software; Digital Airware. Once the form is filled out; a copy of the risk analysis is sent to the pilot's supervisor via email from Digital Airware. Risk assessment rollout to all pilots will be by the end of June.

From: NTSB
To: State of Texas
Date: 4/27/2015
Response: We note that, although your flight operations manual includes procedures that relate to risk assessment, you do not have a formal flight risk evaluation program that incorporates an effect/probability?type risk assessment and predetermined levels of risk that require approval from an individual who is familiar with search and rescue (SAR) operations if the risk reaches an established level. We point out that some other recipients of this recommendation have developed mission-specific flight risk assessment tools that they require pilots to use before all flights. In addition to classifying the risk level as low, medium, or high, the tool calculates a percentage associated with the operational risk. A high-risk flight must be approved by the director of flight operations or a designee one step removed from the launch decision before the flight is accepted. When a medium-risk flight falls near the high end of the range, the flight crew informs the dispatch service that any change in flight conditions, such as deteriorating weather, could render the flight high risk, thus requiring approval before the flight may continue, or even cancelling the flight. We encourage you to review Federal Aviation Administration (FAA) Notice N8000.301, Operational Risk Assessment Programs for Helicopter Emergency Medical Services (HEMS). Although this notice was developed specifically for HEMS operations, it contains guidance on developing an acceptable risk assessment program that can also be tailored to SAR operations. In the meantime, pending our receipt of updates on your progress and completion of the recommended action, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Texas
To: NTSB
Date: 1/5/2015
Response: -From Steven C. McCraw, Director, Texas Department of Public Safety: The Aircraft Operations Division (AOD) believes that the decision to operate an aircraft lies with the Pilot Agent acting as pilot in command (PIC) for that mission and the scope of consideration relating to risk assessment is detailed in Chapter 3 of the AOD Flight Operations Manual (FOM). 45.01 Duties and Responsibilities. The DPS Pilot Agent shall have the sole responsibility for determining if a flight is safe or not in terms of weather, condition of the aircraft and other relevant criteria known by the Pilot Agent at the time the decision is made. Portions of the following duties, with the appropriate authority for their fulfillment, may be performed in association with other departmental Pilot Agents , but the Pilot Agent shall remain responsible to the Lieutenant for his/her performance. He/ She shall: 1. Operate DPS aircraft in a safe and professional manner. 2. Evaluate general safety of aircraft based on mechanical performance and ensure that maintenance and repairs are performed when needed. 3. Prior to each flight, obtain latest weather information and make a decision on the feasibility of proceeding with the flight. If required, prepare and file a flight plan. Inspect the aircraft, test controls, inspect fuel and fluid levels, and perform related safety checks prior to loading passengers and baggage. Be responsible for ensuring that the aircraft is stored, refueled, and maintained properly upon arrival at destination and after return to home station. Chapter 3 of the Flight Operations Manual is a restatement of several requirements listed in the Federal Aviation Regulations I Aeronautical Information Manual (FAR/AIM) for all pilots: FAR PART 91.3- The pilot in command of an aircraft Is directly responsible for, and is the final authority as to, the operation of that aircraft. FAR PART91.7 (b)- The pilot in command of a civil aircraft is responsible for the determining whether that aircraft is in condition for safe flight (has the required maintenance and daily Inspection been performed). FAR PART 91.103- Each pilot in command shall, before beginning a flight, become familiar with all available information concerning that fight. This information must include, weather reports and forecasts, fuel requirements, alternatives available, runway lengths relating to landing distances required, aircraft performance, gross weight, airport elevation, wind, and temperature. Risk assessment for the pilot in command is strongly stated in both the AOD Flight Operations Manual (Chap. 3) and the FAR/AIM. However, at the recommendation of the NTSB Acting Chairman Hart, the DPS AOD Administration will direct the Safety Training Captain to work with the Safety Training Team to explore the formation and implementation of a written risk assessment.

From: NTSB
To: State of Utah
Date: 12/28/2017
Response: We note that, in 2009, the Utah DPS Aero Bureau implemented a policy and procedures manual that includes a formal flight risk evaluation program. The program incorporates an effect/probability?type risk assessment with predetermined levels of risk that require management approval if the risk reaches an established level, and includes training. Because this program was in place before we issued Safety Recommendation A-14-100, the recommendation is classified CLOSED--RECONSIDERED.

From: State of Utah
To: NTSB
Date: 9/27/2017
Response: -From Keith D. Squires, Commissioner: An entire section of the manual addresses risk identification, mitigation and management. High risk tasks and conditions are identified and mitigated through training and use of proper procedures. A matrix is used to determine what the accumulated risk level is and based on this level, who in the chain of command needs to be contacted for approval before a mission can go forward.

From: NTSB
To: State of Utah
Date: 8/3/2017
Response: We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 2 years ago. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE.

From: NTSB
To: Commonwealth of Virginia
Date: 8/3/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the commonwealth of Virginia on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the commonwealth of Virginia on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Washington
Date: 9/16/2015
Response: We note that the WSP’s Aviation Section does not conduct SAR operations; however, we believe that all air operations could benefit from the safety improvements specified in these recommendations. Because these recommendations were specifically aimed at public operators who conduct SAR operations, however, Safety Recommendations A 14-100, -101 and -103 through -106 are classified CLOSED—RECONSIDERED.

From: State of Washington
To: NTSB
Date: 7/29/2015
Response: -From Lieutenant D. Jim Nobach: Reference our phone conversation on Monday, July 27, 2015 concerning follow-up information regarding the A-14-100 questions, the Washington State Patrol (WSP) Aviation Section does not actively engage in Search and Rescue operations. Therefore, the follow-up information previously requested is no longer required of the WSP. At this time we will consider all A-14-100-106 related requests of WSP satisfied. If you have any additional questions, please contact the Washington State Patrol Aviation Section.

From: NTSB
To: State of Washington
Date: 5/4/2015
Response: We note that current WSP procedures require pilots to conduct an individual flight risk assessment prior to each flight. We also note that WSP is in the process of implementing an electronic web-based Flight Risk Analysis Tool (FRAT) that will have an effect/probability type risk assessment and predetermined levels of risk that require approval from a designee one step removed from the launch decision if the risk reaches an established level. However, we would like to know whether all employees involved in operations receive the recommended training. Pending the implementation of your FRAT and our receipt and review of this additional information, Safety Recommendation A-14-100 is classified OPEN—ACCEPTABLE RESPONSE.

From: State of Washington
To: NTSB
Date: 2/20/2015
Response: -From Lieutenant Jim Nobach, Washington State Patrol (WSP) Aviation Chief Pilot: As matter of practice, WSP Aviation makes every effort to maintain an effective and efficient leadership role in aviation safety. This is accomplished through hiring and training staff with the skills, knowledge, and ability to do the job. Secondly, obtaining and utilizing appropriate equipment specific for the mission/s is critical. The WSP currently operates under an internally developed flight risk evaluation program. Pilots are required to conduct individual flight risk assessments prior to each flight mission. The WSP Aviation Section Operations Manual (SOM) identifies the following procedures regarding risk assessment: “Every flight shall be conducted within the scope of Federal Aviation Regulations (FAR), Aeronautical Information Manual (AIM), aircraft operating manuals, and departmental procedures. Crew members shall utilize cockpit resource management skills and shall work together during the decision-making process as to whether a flight should be initiated, continued, or terminated, taking into consideration the weather, condition of aircraft, crew limitations, restrictions or fatigue, and any other hazard.” The WSP Aviation SOM is reviewed and updated annually by the Chief Pilot and Air Operations Safety Officer. Additionally, the WSP is implementing an electronic web-based Flight Risk Analysis Tool (FRAT) onto current Electronic Flight Bag (EFB) equipment which is issued to agency pilots. This online application is simple to use and will have predefined alert levels as risk increases. FRAT features an internal evaluation program; training and qualification tracker; safety related articles; and an integrated read and initial tracking program.

From: NTSB
To: State of West Virginia
Date: 8/1/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of West Virginia on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of West Virginia on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.

From: NTSB
To: State of Wisconsin
Date: 8/2/2017
Response: This letter addresses NTSB Safety Recommendations A-13 21 and A-14-100 through -106. We issued A-13-21 to the state of Wisconsin on May 15, 2013, as a result of our investigations of three accidents in which airplanes inadvertently collided with meteorological evaluation towers, fatally injuring four people. We issued A-14-100 through -106 to the state of Wisconsin on November 24, 2014, as a result of our investigation of the March 30, 2013, accident in which a Eurocopter AS350 B3 helicopter, operated by the Alaska Department of Public Safety, impacted terrain while maneuvering during a search-and-rescue flight near Talkeetna, Alaska. We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others, and we normally expect actions to address our recommendations to be completed within 3 to 5 years. We have yet to hear from you regarding your progress toward addressing these recommendations, which were issued more than 4 and 2 years ago, respectively. We would appreciate receiving a response within 90 days indicating any actions you have taken or plan to take to implement these recommendations; until then, these recommendations will retain their current classification of OPEN—AWAIT RESPONSE. For additional background information about Safety Recommendation A-13-21, please refer to our May 15, 2013, recommendation transmittal letter. For additional background information about Safety Recommendations A-14-100 through -106, please refer to pages 54 through 63 of our Alaska Department of Public Safety Eurocopter accident report.